InSitu Simulation and Systems Testing Dr Pamela Winton

In-Situ Simulation and ‘Systems Testing’ Dr Pamela Winton Dr David Rowney Royal Hospital for Sick Children Edinburgh

• • • Overview of simulation In-situ simulation Our experience A strategy to engage management. . . ‘Systems Testing’ • Group work

Clinical Simulation • Rapid rise in Clinical Simulation – Technology and Facilities – Litigation and Insurance – Fellowships and Research – Validated for assessment • ‘Safer Medical Practice: Machines, Manikins and Polo Mints’ CMO England 2008 • ‘A Framework for Technology Enhanced Learning’ DH 2011

Evidence • Med. Teams – Clinical Error reduction from 30% to 4. 4% • PROMPT – Neonatal hypoxic injuries – 50% reduction – Injuries after shoulder dystocia – 70% reduction – Improvements in performance in Cat 1 sections

In-situ Simulation • Real time, real areas, real challenges • Reveal gaps in the ‘system’ – Equipment, process, training • Simulation and Debrief • Document information – DATIX, Risk Register, FMEA Analysis, Report • Action • Re-Test

Our experience • • • RHSC Research Facility New Clinical Trial – ‘SNIFFLE Study’ High Risk Anaphylaxis Prospectively test system Re-test • In-situ, real time emergency team response

Our experience • Clinical management • Equipment • Debrief – Still difficulties accessing area • Some issues resolved, some not • Solutions? • Re-test

Activity • Work with those around your table and develop a single idea for an insitu simulation designed to test a workplace system. • Your group will be asked to present a summary of your idea, sketched out on flipchart paper, to the room

Discuss how you could use simulation for system’s testing in your work place • • What do you want to test? Why do you want to test this? How would you set it up? What resources will you need? What barriers might you face? What will you do with the findings? When would you ‘re-test’?

But we don’t have a fancy manikin! • Simulation a technique not a technology. . . • Expertise of facilitator most important element of effective simulation-based education • Emergency algorithms, drills

In-situ Systems Testing Novel applications for Simulation • Evaluate established work processes and systems • Investigate reported errors, faulty systems and patient safety concerns • Test new equipment and technologies in reallife setting prior to patient exposure • Test, modify, adapt and orient healthcare providers to new processes, services, and facilities before introducing to patients

The challenges of in-situ simulation - Real or imagined? Fidelity - highest not always best! Faculty - worth investing in and key to success Time - compromise might need to be met Staff not engaging - high face & content validity means this is the exception rather than the rule • Cost - link with patient safety initiatives, engage with management, report findings! • •

Thank you!

A framework for the measurement and monitoring of safety Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013. www. health. org. uk/publications/the-measurement-and-monitoring-of-safety